This application addresses broad Challenge Area #5 - Comparative Effectiveness Research and specific Challenge Topic #05-AG-105 - Comparative Intervention Trials for Diseases and Syndromes of Aging Including Neurodegenerative Diseases. Recent research has shown evidence of neural plasticity at older ages and that cognitive exercise or training may help performance and delay age-related cognitive decline and various forms of dementia. Previous approaches to cognitive training have generally been fairly focused, and have had difficulty in translating possible gains in cognitive performance on specific tasks to improved functioning in everyday activities. We hypothesize that a continuous, multi-faceted cognitive intervention will more likely transfer to everyday activities and improvements in quality of life. In this planning project, we propose to integrate cognitive intervention protocols into our health coaching technology and evaluate the feasibility of a novel and scalable method for delivering tailored cognitive health interventions to elders in their home environment. Our development and pilot evaluations in this project are designed as preparation for a larger clinical trial evaluating the effectives of various sustained cognitive interventions delivered over longer periods of time with our remote health coaching technology. The new development will build upon our group's previous work in the area of cognitive monitoring through the use of adaptive computer games, as well as on our work with a Web-based health coaching platform for delivering health interventions to elders in their homes. We plan to develop and adapt modular protocols for known interventions that can be delivered to the home, including physical exercise, cognitive computer exercise, sleep management, socialization and novelty exercises. These protocols include a mix of activities that can be automatically monitored, such as actigraph measures of physical activity, performance metrics from the cognitive computer exercises, and sleep quality metrics from the pressure-sensitive bed mats. In addition, we will monitor activities requiring self-report self report via our Web-based coaching interface or via an automated cell phone interface. Our coaching technology uses known successful techniques for health coaching, such as motivational interviewing and tailored messaging based on readiness-to-change. The proposed benefits of this multi-pronged approach to providing a tailored cognitive health intervention for elders are 1) it is scalable and low-cost, relying on software that facilitates a single coach in managing potentially hundreds of patients;2) it offers a variety of approaches to improving cognitive performance and may be more likely to generalize to everyday activities;3) it includes daily activities that will amplify the effect;and 4) the modular platform can serve as a research vehicle for testing any home cognitive training intervention, with coaching encouragement and feedback. After the development and integration of the new modules to our Health Coaching Platform, we will test the feasibility and sustainability of delivering three interventions: 1) physical exercise, 2) cognitive computer exercise, and 3) a combined set of interventions including physical and cognitive exercise, sleep management, novelty exercises and socialization. We will test and optimize our ability to deploy the technology and sustain the interventions over one year by conducting a pilot field trial with 45 elderly participants living independently (15 participants in each arm of the study). We will use the research infrastructure of the Oregon Roybal Center for Aging &Technology (ORCATECH), including their tools for subject recruitment, data management, and neuropsychological assessments. Through this project we hope to provide a robust and scalable platform for testing sustainable cognitive interventions in the home, specifically preparing study recommendations for a clinical trial comparing the effectiveness of physical exercise, cognitive computer exercise, and a multi-part intervention through via coaching technology to older adults in their homes. This project is important to public health because it provides a scalable, low-cost new approach to delivering quality care to elders in the home. This new platform for cognitive health coaching addresses the functional and quality-of-life issues that are most important to our senior citizens. In addition, by offering a multi-faceted intervention that includes physical exercise, diet, and sleep management, we are more likely to be able to show outcomes that generalize to everyday functioning.